More than 270,000 km of rivers and streams are impaired due to fecal pathogens, creating an economic and public health burden. Fecal indicator organisms such as Escherichia coli are used to determine if surface waters are pathogen impaired, but they fail to identify human health risks, provide source information, or have unique fate and transport processes. Statistical and machine learning models can be used to overcome some of these weaknesses, including identifying ecological mechanisms influencing fecal pollution. In this study, canonical correlation analysis (CCorA) was performed to select parameters for the machine learning model, Maxent, to identify how chemical and microbial parameters can predict E. coli impairment and F+-somatic bacteriophage detections. Models were validated using a bootstrapping cross-validation. Three suites of models were developed; initial models using all parameters, models using parameters identified in CCorA, and optimized models after further sensitivity analysis. Canonical correlation analysis reduced the number of parameters needed to achieve the same degree of accuracy in the initial E. coli model (84.7%), and sensitivity analysis improved accuracy to 86.1%. Bacteriophage model accuracies were 79.2, 70.8, and 69.4% for the initial, CCorA, and optimized models, respectively; this suggests complex ecological interactions of bacteriophages are not captured by CCorA. Results indicate distinct ecological drivers of impairment depending on the fecal indicator organism used. Escherichia coli impairment is driven by increased hardness and microbial activity, whereas bacteriophage detection is inhibited by high levels of coliforms in sediment. Both indicators were influenced by organic pollution and phosphorus limitation.

No description available.

The proportion of obese adolescents in Southern Appalachia is among the highest in the nation. Currently there are few effective programs that address this issue, especially among high school students. Through funding from the National Institute on Minority Health and Health Disparities in the National Institutes of Health, the Team Up for Healthy Living Project targets obesity prevention in adolescents through a crosspeer intervention. The specific aims of the project are: 1) To develop a peer-based health education program focusing on establishing positive peer norms and supportive peer relationships toward healthy eating and physical activity among high school students, 2) To test the efficacy of the program, and 3) To explore the mechanisms underlying the program. The intervention is based on the Theory of Planned Behavior, which presupposes that human behavior is primarily driven by attitude, subjective norms, perceived behavior control, and social support. Through influencing these components, the intervention is expected to improve eating behavior, increase physical activity, and lead to healthier body weight among adolescents in Southern Appalachia. Ten area high schools were selected to be a part of the project, and schools were matched based on similar demographics (school size and number of students enrolled) and were randomized to intervention or control. Wave one of baseline data collection was completed in January 2012; with 265 students assigned to intervention and 276 to control. A second wave of subject recruitment will occur in fall 2012. To deliver the intervention, undergraduate students from the disciplines of Public Health, Nutrition, and Kinesiology were trained as peer facilitators. These peer facilitators are teaching the eight-week Team Up curriculum during Lifetime Wellness classes at intervention schools. The curriculum focuses on nutrition awareness, physical activity, leadership, and communication skills. Page 84 2012 Appalachian Student Research Forum Control group participants receive their regularly scheduled Lifetime Wellness curriculum. Body mass index percentile, dietary behavior, and physical activity among study subjects will be assessed at baseline, and at three and twelve months post-baseline. In addition, peer group norms, body image, supportive peer relationships, role modeling, behavioral control/self-efficacy, attitudes, and intentions toward healthy eating and physical activity will also be assessed. Group differences will be assessed at each data collection period. The long-term goal of the study is to establish an effective academia-community partnership program to address adolescent obesity disparity in Southern Appalachia.

No description available.

In an effort to bridge the gap between public health practice and academia, the Health Resources and Services Administration (HRSA)-funded Tennessee Public Health Training Center (LIFEPATH) has supported establishment of an Academic Health Department (AHD) involving the East Tennessee State University (ETSU) College of Public Health (COPH) and the Sullivan County Regional Health Department (SCRHD). The SCRHD identified a need to increase internal capacity to conduct ongoing community health assessments and community-oriented practice. Similarly, the COPH recognized the need to expand field-based public health practice opportunities for students. Personnel from SCRHD, LIFEPATH, and COPH developed a formal AHD memorandum of understanding during the summer of 2012, launching the program in fall 2012. The COPH/SCRHD model addresses financial barriers experienced by other AHDs by competitively awarding the Coordinator position to a Doctor of Public Health (DrPH) student from the COPH, demonstrating investment in the model by the COPH. The DrPH student gains valuable leadership experience through project management, coordination of the local health council, and day-to-day facilitation of undergraduate and master's student interns. SCRHD benefits from formally trained graduate-level interns dedicated to long-term work within the community. This AHD offers a unique opportunity for doctoral-level students to develop practical leadership skills in a functioning health department, while enhancing the capacity of SCRHD and COPH to serve their community and stakeholders.

Background: Adverse childhood experiences (ACEs) lead to high risk behaviors in adults. Annually, around 10,000 people die from alcohol-related motor vehicle injuries, and >1.1 million arrested for driving under the influence of alcohol or narcotics. An estimated 700,000 children reported abuse each year; 8.4% reported experiencing sexual abuse. Studies have reported the role of ACEs in alcohol consumption during adulthood. Additionally, evidence exists about the influence of parental substance abuse behaviors on addiction to alcohol and other substances of abuse. However, the association of adult drunk driving with childhood sexual abuse, and /or exposure to parental substance abuse behaviors has not been investigated. Objective: This study aimed to estimate the association of sexual abuse and/or parental substance abuse behaviors during childhood 2017 Appalachian Student Research Forum Page 57with drunk driving in US adults. Methods: Data were obtained from 4,374,390 adults who participated in the 2012 Behavioral Risk Factor Surveillance System (BRFSS). Participants' self-reported responses were used to define study outcome- drunk driving (no/yes) and study exposure- childhood sexual abuse (no/yes) and parental substance abuse behavior (no/yes). Covariates included age, sex, race, income, education, and marital status. Simple and multivariable logistic regression models were used to assess the relative odds of drunk driving among US adults who reported sexual abuse and/or exposure to parental substance behaviors during childhood. Interaction models were conducted to test for joint effects of study exposures on the outcome. Results: Approximately 3.6% of adults reported DD, 10.55% reported exposure to parental substance abuse behavior, and 11.1% adults reported childhood sexual abuse. Compared to adults who didn't experience sexual abuse during childhood, those who experienced were significantly associated with increased odds of drunk driving behavior (adjusted Odds Ratio (aOR): 1.67, 95% confidence interval (CI):1.27-2.20). Adults who reported exposure to parental substance abuse behavior were found to be associated with increased odds of drunk driving behavior (aOR:1.30, 95%CI:1.00-1.68) compared to unexposed adults. Conclusion: Adults who were sexually abused during childhood and had exposures to parental substance abuse behaviors were associated with increased relative odds of drunk driving. The study findings help public health professionals identify targeted high risk groups for interventions. Appropriate public health interventions and/or policies should be developed to prevent sexual abuse and exposure to parental substance abuse during childhood. Health education and promotional campaigns are vital to minimize drunk driving cases by targeting communities and individuals with high risk behaviors.

Introduction: More than one-third of adults and 17% of children/adolescents in the US are overweight or obese contributing to significant morbidity and mortality, and healthcare costs. Studies have reported the persistence of adolescent obesity to adulthood, resulting in increased risk of chronic diseases such as asthma, type 2 diabetes mellitus, cardiovascular, and liver diseases. Little is known about obesity patterns in subethnic populations in the US with high prevalence of obesity or overweight reported in Hispanic youth (21.9%) compared to non-Hispanic blacks (19.5%) and non-Hispanic whites (14.7%). Several genetic, uterine, and nutritional factors, and unhealthy behaviors were identified as risk factors. Evidence is emerging about the possible role of generational status in influencing adolescent obesity. The purpose of this study is to assess the association of generation status with adolescent overweight or obesity in Hispanics in the US. Methods: Data from the 2011-2012 National Survey of Children's Health (NSCH)were used to conduct this study. Only Hispanic adolescents aged 10 to 17 years were included as study population. Using the age-sex-race specific cut-off points, we defined adolescent as being overweight or obese if they were above 85th or 95th percentile cut off point values for BMI. Generation status of an adolescent was categorized into three groups: a) generation 1 for those who were not born in US or to US citizens abroad, and migrated to US as children, b) generation 2 are those born in US but have at least one parent who is foreign born, and c) generation 3 or higher adolescents are those born in US to native-born parents. Multivariable models were conducted to test the association of generation status with adolescent obesity in Hispanics, adjusting for potential confounders. Results: A total of 5,217 Hispanic adolescents were included in the study. Approximately 1,650 and 31.7% of adolescents reported being overweight or obese. Approximately 857, 2,216 and 2,144 of adolescents are 1st, 2nd and 3rd generation Hispanic youth. Comparing to 3rd generation adolescents, those belonging to 1st and 2ndgenerations were associated with increased odds of adolescent obesity in Hispanics OR1.48, 95% CI 1.177 – 1.867 and OR 1.405, 95% CI 1.227-1.610 for 1st and 2nd generation, respectively. Conclusion: Generational status is associated with increased relative odds of overweight or obesity in Hispanic adolescents. Aggregated estimates not accounting for nativity or county of origin of an adolescent contribute to significant heterogeneity or disparities in obesity prevalence or patterns, with implications for generation-specific interventions.

Maintaining the health of Tennesseans depends heavily on a well-trained, efficient public health workforce that can work effectively in a complex environment. In order to assess the training needs of this group, the Tennessee Public Health Training Center-LIFEPATH administered a survey to all governmental public health employees in Tennessee during the summer of 2012. This instrument was modeled after previous assessments conducted by health agencies outside of Tennessee which utilized as their rubric the Core Competencies for Public Health Professionals developed by the Council on Linkages between Academia and Public Health Practice. The goal of this research was to inform and streamline educational efforts of the Tennessee Department of Health (TDOH), LIFEPATH and their partners across the state by identifying specific competency driven training opportunities within the workforce. Participants were recruited via email and directed to SurveyMonkey, an online survey toolkit, where they could complete the questionnaire. Of the 5178 TDOH employees who received the recruitment email, 3086 individuals completed at least one of the competency questions for a response rate of 59.6%. The survey assigned questions pertinent to the eight core competency areas to respondents based on one of three Tiers – Tier 1: Entry Level, Tier 2: Management Level, Tier 3: Leadership Level. Once the data were collected, responses from all three tiers were dichotomized to generate a “Needs Score” which when summarized represented the percentage of responses indicating a lack of knowledge or proficiency in a competency area. Tier 1 respondents had an average needs score of 60.46% in each of the eight core competency areas. Tier 2 had an average needs score of 49.50%, and Tier 3 respondents had an average needs score of 28.91%. This trend shows that individuals in leadership positions within TDOH were more likely to be knowledgeable or proficient in the eight core competency areas. Prior to administering the survey, TDOH job classifications were submitted to an expert panel within the health department. This body was tasked with assigning tiers to specific job classifications. Previous needs assessments that used the eight core competencies had respondents self-select their tier. As a test of validity the LIFEPATH survey asked TDOH employees to select their job classification in addition to tier. A Kappa test of agreement between self-selection of tier and their actual tier determined by TDOH leadership showed moderate agreement (Kappa=0.5089), suggesting that while most respondents selected the correct tier; there remained some confusion regarding tier definitions. This must be considered when evaluating the results of previous studies that utilize only the self-selected tiers to drive their survey. This data has already begun to direct training goals at the state, regional and local levels across Tennessee and will serve as a baseline measure for future evaluations of educational programing’s impact on workforce competency.

Abstract available through the Journal of the American College of Cardiology.

Background: HIV- and MSM-related stigma are well documented as common for Chinese men who have sex with men (MSM) living with HIV, yet there is sparse literature on intimate partner violence (IPV) and its relationship with stigma in this vulnerable population. To evaluate the association between HIV-stigma and stigma related to homosexuality and IPV among newly HIV-diagnosed MSM in China. Methods: Data were collected in the baseline survey among newly HIV-diagnosed Chinese MSM in a randomized clinical trial via face-to-face interviews. Univariate logistic and multivariate logistic regression analyses were performed to assess the associations between IPV and HIV- and MSM-related stigma. Results: Of 367 newly HIV-diagnosed Chinese MSM, 23.7% experienced any IPV, including 16.6% physical, 7.4% psychological and 5.2% sexual IPV. Positive associations were found between HIV- and MSM-related stigma and IPV. Men with high HIV-related stigma (score ≥ 27) were 1.67 times as likely to experience any IPV as those with low stigma (adjusted odds ratio [AOR]: 1.67, 95% confidence interval [CI]: 1.02-2.76). Men with high MSM-related stigma (score ≥ 6) were 1.99 times as likely to experience any IPV as those with low stigma (AOR: 1.99, 95% CI: 1.18-3.36). Conclusions: HIV- and MSM-related stigmas was positively associated with IPV experiences among newly diagnosed MSM in China. The manner in which stigma may exacerbate IPV, and/or the influence of IPV on worsening stigma should be further evaluated. The high prevalence of IPV and stigma in this population suggests that interventions should be taken to reduce stigma and prevent this risky behavior among MSM.